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「慢性閉塞性肺疾患(COPD) 現状と課題」の記事抜粋 [喫煙による危険]

第2732号 2007年5月21日


【Medical Frontline】

慢性閉塞性肺疾患(COPD) 現状と課題

相澤久道(久留米大学医学部呼吸器・神経・膠原病内科教授(第一内科))

COPD(慢性閉塞性肺疾患:Chronic Obstructive Pulmonary Disease)が世界的に重要視されているのは,(1)有病率と死亡率が高く... 

COPDの実態とその重要性

 WHOの調査では,COPDは世界の死亡原因の第4位にランク... 

他の欧米諸国でも45歳以上のCOPD有病率は5.5-9.5%と報告されていますが,わが国の厚生労働省からはCOPD患者数は約20万人と報告されていました。ところが,2001年に発表された...日本ではCOPDは少ないと考えられていましたが,実際には多くの患者さんがいるのにきちんと診断を受けていないという実態が浮き彫りにされました。

第一には「COPDは非可逆性の疾患であり,治療法がない」という消極的な考えがあり...   

COPDの病態と診断...   

原因の大半は喫煙です。煙草は,末梢気道に炎症を起こします。早期には変化は軽度であり可逆性を示しますが,煙草への曝露が長期にわたると炎症は慢性化し,気道の線維化と狭窄,肺胞の破壊による肺弾性収縮力の低下,小気道の開通性を維持している肺胞支持部の破壊が起こり,可逆性に乏しくなってきます。

症状としては,咳と痰は早期より,息切れはある程度進行してから認められます。老化や風邪などと考えられて見過ごされやすいため... 

 

 

 COPDスクリーニングのための質問票
   ※17ポイント以上の場合,「COPD診療ガイド」に進む。
質問 選択肢 ポイント
1.あなたの年齢はいくつですか? 40-49歳 0
50-59歳 4
60-69歳 8
70歳以上 10
2.1日に何本くらい,タバコを吸いますか?
(もし,今は禁煙しているならば,以前は何本くらい吸っていましたか?)
今まで,合計で何年間くらい,タバコを吸っていましたか?
〔1日の喫煙箱数=1日のタバコ数/20本(1箱入数)〕
Pack・year=1日の喫煙箱数×喫煙年数
0-14Pack・year 0
15-24Pack・year 2
25-49Pack・year 3
50Pack・year以上 7
3.あなたの体重は何キログラムですか?
あなたの身長は何センチメートルですか?
〔BMI=体重(kg)/身長(m)2
BMI<25.4 5
BMI 25.4-29.7 1
BMI>29.7 0
4.天候により,せきがひどくなることがありますか? はい,天候により
ひどくなることが
あります
3
いいえ,天候は
関係ありません
0
せきは出ません 0
5.風邪をひいていないのに痰がからむことがありますか? はい 3
いいえ 0
6.朝起きてすぐに痰がからむことがよくありますか? はい 0
いいえ 3
7.喘鳴(ゼイゼイ,ヒューヒュー)がよくありますか? いいえ,ありません 0
時々,もしくはよく
あります
4
8.今現在(もしくは今まで)アレルギーの症状はありますか? はい 0
いいえ 3
日本呼吸器学会HPのIPAG診断・治療ハンドブック日本語版より閲覧可

COPDの治療方針

重症度に応じて段階的な薬物療法...  


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COPD慢性閉塞性肺疾患 (よくわかる最新医学) (単行本) [編集]

木田 厚瑞 (著) 


内容紹介
タバコの害というと、まず肺がんがあげられますが、実は患者数で最も多いのがCOPD、慢性閉塞性肺疾患です。現在、日本で診断されている患者数は20数万人ですが、推定の患者数は五百万人とも七百万人ともいわれており、年間死亡者数は1万4千人余りで死因第10位ですが、年々増加傾向にあり、世界では2020年には死因第3位になると予測されています。最初はせきやたんや息切れで始まって、ゆっくり進むので見過ごされがちで、重症化して初めて診断・治療の対象になることが多いため、常時酸素吸入が必要になったり、寝たきりになったりする怖い病気です。ただ早く発見してきちんと治療すれば、進行を止めることができ、脳卒中・肺炎・心臓病といった合併症も予防できます。本書は、早期発見を可能にするチェックリストや肺年齢の測定、治療の第1歩である禁煙、新しい気管支拡張薬、呼吸リハビリテーション、日常生活の心得など、必要な情報を満載。 

内容(「BOOK」データベースより)
タバコ病で死なないために。潜在患者数500万人以上ともいわれる21世紀の生活習慣病。最新の検査法・治療法と療養のコツで寝たきり防止。病気の悪化を防ぎ、肺の機能を回復させる禁煙のすすめ。 

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